Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
Injury. 2021 Oct;52(10):2986-2990. doi: 10.1016/j.injury.2021.08.001. Epub 2021 Aug 4.
Intravenous tranexamic acid (TXA) administration is a proven safe and effective method for reducing both blood loss and transfusion in total joint arthroplasty. However, data specific to its efficacy in hip hemiarthroplasty (HHA) for femoral neck fracture are scarce. Furthermore, no study has investigated the efficacy of an additional dose of TXA administration. Accordingly, this study aimed to assess blood loss and the transfusion rate compared among different regimens of TXA administration in patients undergoing HHA for femoral neck fracture.
Between January 2019 to December 2020, 90 HHA patients were randomized into one of three groups (30 patients/group). Control group patients received intravenous normal saline solution (NSS) 20 mL before skin incision, and NSS 20 mL at 3 hours after surgery. one-dose (1D) group patients received 750 mg of intravenous TXA before skin incision, and NSS 20 mL at 3 hours after surgery. Two-dose (2D) group patients received 750 mg of intravenous TXA before skin incision, and 750 mg of TXA at 3 hours after surgery. The primary outcome was blood transfusion rate. Intraoperative blood loss, hemoglobin levels at 24- and 48-hours postoperation, and calculated total blood loss were compared among the three groups.
The mean age of the study population was 79.7 years, and 76.7% of participants were women. The transfusion rate in the control, 1D and 2D groups was 43.3%, 16.7%, and 3.3%, respectively. Total hemoglobin loss; total red blood cell loss; intraoperative blood loss; hemoglobin level at 24- and 48-hours postoperation; change in hemoglobin level between 0 and 24 hours, and between 0 and 48 hours; blood transfusion rate; and, the number of patients who did not require blood transfusion were all significantly improved in the 2D group compared to baseline. No parameters were significantly improved in the 1D group compared to controls.
The results of this study demonstrate both the efficacy of TXA administration in HHA, and the superiority of two-dose TXA administration over one-dose TXA administration in HHA for femoral neck fracture.
静脉注射氨甲环酸（TXA）已被证明是一种安全有效的方法，可减少全髋关节置换术的失血量和输血量。然而，关于其在股骨颈骨折半髋关节置换术（HHA）中的疗效的数据却很少。此外，尚无研究探讨额外剂量 TXA 给药的疗效。因此，本研究旨在评估不同 TXA 给药方案在股骨颈骨折行 HHA 患者中的失血和输血率。
2019 年 1 月至 2020 年 12 月，90 例 HHA 患者随机分为三组（每组 30 例）。对照组患者在切开皮肤前给予 20ml 静脉生理盐水溶液（NSS），术后 3 小时给予 20ml NSS。一剂（1D）组患者在切开皮肤前给予 750mg 静脉 TXA，术后 3 小时给予 20ml NSS。两剂（2D）组患者在切开皮肤前给予 750mg 静脉 TXA，术后 3 小时给予 750mg TXA。主要结局为输血率。比较三组患者的术中失血量、术后 24-48 小时的血红蛋白水平和计算的总失血量。
研究人群的平均年龄为 79.7 岁，76.7%的参与者为女性。对照组、1D 组和 2D 组的输血率分别为 43.3%、16.7%和 3.3%。2D 组总血红蛋白丢失量、总红细胞丢失量、术中失血量、术后 24-48 小时血红蛋白水平、0-24 小时和 0-48 小时血红蛋白水平变化、输血率和无需输血的患者人数均明显优于基线水平。1D 组与对照组相比，无参数明显改善。
本研究结果表明，TXA 给药在 HHA 中的疗效，以及在股骨颈骨折行 HHA 时两剂 TXA 给药优于一剂 TXA 给药。
Zotero 插件